Electronic Health Records Can Present Ongoing Patient Safety Concerns

Dr. Hardeep Singh MD, MPH Chief the Health Policy, Quality & Informatics Program Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center in Houston, Texas Associate professor at Baylor College of MedicineMedicalResearch.com Interview with:
Dr. Hardeep Singh MD, MPH
Chief the Health Policy, Quality & Informatics Program
Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety
Michael E. DeBakey VA Medical Center in Houston, Texas
Associate professor at Baylor College of Medicine

MedicalResearch: What are the main findings of the study?

Dr. Singh: EHRs use can prompt new patient safety concerns, and many of these problems are complex and difficult to detect. We sought to better understand the nature of these patient safety concerns and reviewed 100 closed investigations involving 344 technology-related incidents arising between 2009 and 2013 at the Department of Veterans Affairs (VA).

We evaluated safety concerns related to technology itself as well as human and operational factors such as user behaviors, clinical workflow demands, and organizational policies and procedures involving technology. Three quarters of the investigations involved unsafe technology while the remainder involved unsafe use of technology. Most (70%) investigations identified a mix of 2 or more technical and/or non-technical underlying factors.

The most common types of safety concerns were related to the display of information in the EHR; software upgrades or modifications; and transmission of data between different components of the EHR system.


MedicalResearch: Were any of the findings unexpected?

Dr. Singh: EHR-related safety concerns involving both unsafe technology and unsafe use of technology persist long after ‘go-live’ and despite the sophisticated EHR infrastructure represented in our data source.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Singh: Despite sophisticated technology, electronic health records (EHRs) can present patient safety concerns long after they “go live”. This is not just a technology-related problem–we recommend taking a ‘sociotechnical’ approach to understand and fix these issues. The VA adopted EHRs in 1999 and is a leader in patient safety and the use of health information technology. It runs a non-punitive voluntary reporting system for health information technology safety reporting and analysis. Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA. As more institutions adopt EHRs within and outside the U.S., we suggest that our findings may be useful in guiding broader proactive efforts to ensure close monitoring of patient safety in EHR-enabled health care settings.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Singh: Research on how to develop and operationalize sophisticated monitoring systems to unearth the complex mix of human and technological causes behind these problems is needed.

Citation:
An analysis of electronic health record-related patient safety concernsDerek W Meeks,Michael W Smith,Lesley Taylor,Dean F Sittig,Jean M Scott,Hardeep Singh

J Am Med Inform Assoc amiajnl-2013-002578Published Online First: 20 June 2014 doi:10.1136/amiajnl-2013-002578

 

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